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TRT vs. enclomiphene: which testosterone treatment is right for you?
Quick answer
Testosterone replacement therapy (TRT) adds testosterone to your body directly. Enclomiphene is a daily capsule that signals your body to make more of its own.
In clinical studies, enclomiphene raised testosterone while keeping sperm counts in the normal range, while testosterone gel lowered sperm production.
At Surna, TRT starts at $99/mo and enclomiphene at $119/mo. Both start with labs and a video visit.
Updated · Sources below
Side by side
| Feature | TRT (testosterone) | Enclomiphene |
|---|---|---|
| How it works | Replaces testosterone | Stimulates your own production |
| Form at Surna | Weekly injection or daily cream | Daily capsule |
| Effect on sperm production | Can lower it | Maintained in clinical studies |
| FDA status | FDA-approved | Not FDA-approved; compounded |
| Controlled substance | Yes, Schedule III | No |
| Works if the testes don’t respond | Yes | No, it needs working testes |
| Before starting | Labs and a video visit | Labs and a video visit |
| Surna starting price | $99/mo | $119/mo |
Which is right for you?
Your provider makes the final call based on your health history.
Choose TRT (testosterone) if
- Your labs show your testes aren’t responding to hormone signals
- You’re not planning to have children soon
- You want an FDA-approved medication
Choose Enclomiphene if
- You want to preserve fertility
- You’d rather take a daily capsule than injections
- Your labs show a low signal from the pituitary gland
Replacement vs. restoration
TRT supplies testosterone from outside the body. Because the body senses enough testosterone, it slows its own production and sperm production can drop. Enclomiphene works upstream: it blocks estrogen’s feedback in the brain so the pituitary gland sends a stronger signal to the testes.
What the research shows
In randomized phase III studies of overweight men with secondary hypogonadism, enclomiphene increased testosterone, LH, and FSH and kept sperm concentrations in the normal range, while testosterone gel lowered LH, FSH, and sperm production.
Enclomiphene only works when the testes can respond, which is why labs come first.
Monitoring
Both require follow-up labs. TRT monitoring includes testosterone, red blood cell counts, and PSA. Enclomiphene monitoring includes testosterone and estrogen levels. Stop enclomiphene and contact your provider if you notice vision changes.
Questions, answered
Will TRT make me infertile?
It can lower sperm production while you’re on it. Production often recovers after stopping, but it can take time. If fertility matters to you, ask your provider about enclomiphene.
Can I switch from TRT to enclomiphene?
Sometimes. Your provider reviews your labs, since enclomiphene depends on your body’s own hormone signaling.
Is enclomiphene FDA-approved?
No. Enclomiphene is compounded by a state-licensed pharmacy and is not FDA-approved.
Which raises testosterone more?
Both can bring testosterone into a normal range. The better choice depends on the cause of your low testosterone and whether you want to preserve fertility.
Sources
- Kim ED, McCullough A, Kaminetsky J. Oral enclomiphene citrate raises testosterone and preserves sperm counts in obese hypogonadal men, unlike topical testosterone. BJU Int. 2016;117:677-685. Source
- Wiehle RD, et al. Enclomiphene citrate stimulates testosterone production while preventing oligospermia: a randomized phase II clinical trial comparing topical testosterone. Fertil Steril. 2014;102:720-727. Source
- DailyMed. Testosterone cypionate injection prescribing information. Source
This page is general information, not medical advice. A licensed provider will determine whether treatment is appropriate for you. Individual results vary. Wegovy®, Ozempic®, and Rybelsus® are registered trademarks of Novo Nordisk; Zepbound® and Mounjaro® of Eli Lilly and Company; Viagra® of Viatris; Cialis® of Eli Lilly and Company. Surna Health is not affiliated with these companies.
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